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[乙肝肝硬化患者中医证候及其要素的生化特征]

[Biochemical characteristics of traditional Chinese medicine syndromes and their elements in patients with hepatitis B cirrhosis].

作者信息

Yuan Ji-li, Zhang Hua, Wang Lei, Lin Yan, Hu Xin-cai, Zhang Qin, Liu Ping

机构信息

Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.

出版信息

Zhong Xi Yi Jie He Xue Bao. 2011 Apr;9(4):374-81. doi: 10.3736/jcim20110405.

Abstract

OBJECTIVE

To investigate the characteristics of traditional Chinese medicine (TCM) syndromes and their elements in patients with post hepatitic cirrhosis by analyzing the relationships between signs and symptoms and biochemical parameters.

METHODS

A total of 440 patients with hepatitis B cirrhosis treated in Shanghai Public Health Center and Shuguang Hospital, Longhua Hospital and Central Hospital of Putuo District Affiliated to Shanghai University of Traditional Chinese Medicine during January 2002 to January 2006 were enrolled in this study. Signs and symptoms and biochemical information of patients were collected by using a self-designed questionnaire regarding the four examinations of TCM. Signs and symptoms were firstly analyzed to find the frequency of occurrence. Then, the patients were divided into two groups according to non-existent or existent sign and symptom and the correlations between the signs and symptoms which occurred most frequently and their biochemical parameters were analyzed.

RESULTS

Sixteen symptoms which occurred most frequently were fatigue, colored urine, liver palms, opaque complexion, string-like pulse, weakness at waist and knees, dry month and bitter taste in the mouth, profuse dreaminess and poor sleepiness, heaviness of limbs, abdominal distention, yellow eyes, fine pulse, impetuosity and susceptibility to rage, splenomegaly, poor appetite, and distension and fullness in the chest and hypochondrium. A previous study on syndrome differentiation of 900 patients with post hepatitic cirrhosis showed 4 syndrome patterns: internal accumulation of dampness-heat, liver-kidney yin deficiency, internal accumulation of blood stasis-heat, and liver depression and spleen deficiency. Further analysis showed that internal accumulation of dampness-heat syndrome was characterized by obvious hepatic inflammation, poor synthesis function and more ascites. Liver-kidney yin deficiency syndrome was characterized by low-level hepatic inflammation, poor synthesis function and more ascites. Internal accumulation of blood stasis-heat syndrome was characterized by low-level hepatic inflammation, poorer synthesis function, ascites and splenomegalia, and liver depression and spleen deficiency syndrome was characterized by slight hepatic inflammation, synthesis function injury, decreased internal portal vein diameter and less ascites.

CONCLUSION

Different syndrome patterns have different pathological features, showing the complexity and polymorphism of syndrome construction.

摘要

目的

通过分析症状体征与生化指标之间的关系,探讨肝炎后肝硬化患者的中医证候特征及其要素。

方法

选取2002年1月至2006年1月期间在上海公共卫生临床中心、上海中医药大学附属曙光医院、龙华医院及普陀区中心医院就诊的440例乙肝肝硬化患者。采用自行设计的中医四诊调查问卷收集患者的症状体征及生化信息。首先分析症状体征的出现频率,然后根据症状体征的有无将患者分为两组,分析出现频率最高的症状体征与其生化指标之间的相关性。

结果

出现频率最高的16个症状为乏力、尿黄、肝掌、面色晦暗、弦脉、腰膝酸软、口干口苦、多梦少寐、肢体困重、腹胀、目黄、细脉、急躁易怒、脾肿大、纳差、胸胁胀满。既往对900例肝炎后肝硬化患者的辨证研究显示有4种证型:湿热内蕴、肝肾阴虚、血瘀热结、肝郁脾虚。进一步分析表明,湿热内蕴证以肝脏炎症明显、合成功能差及腹水较多为特征;肝肾阴虚证以肝脏炎症程度低、合成功能差及腹水较多为特征;血瘀热结证以肝脏炎症程度低、合成功能较差、有腹水及脾肿大为特征;肝郁脾虚证以肝脏炎症轻微、合成功能受损、门静脉内径减小及腹水较少为特征。

结论

不同证型具有不同的病理特征,体现了证候构成的复杂性和多态性。

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